Don't get all feministical on me.

Q: Why do men get so damned noisy sinusistically speaking when they reach middle age? My husband clears his throat and manipulates his snot in the noisiest manner, and he's a deep-voiced, big guy, so it is loud!!! I don't know any women who do this. He manages to keep it at bay when in public. He has had his sinuses done successfully (with that headpiece and software-directed surgery) and does not have any allergies that i know of. Can you suggest any causes or whom to go see for this? I am seriously ready to clock him! Or should I call a lawyer?

A: Sinusistically. As a writer, I love that word, love it to death.

First off, let's dispense with the sexism right away. Women get this too. The fact that they don't hawk and snort only means they don't do that around YOU. As you mentioned, he only does it around you, which is a testimony to how comfortable he is in your presence. The big galoot must really love you.

Good. Now that you're feeling better about the hubs, what are we going to do about the snorting? My hunch -- and this could easily be confirmed by having his ENT scope his nasal passages at an early morning appointment (make sure your hubs doesn't clear everything out before going in!) -- is that this is a mucus problem. Even if he's had sinus surgery, his sinus cavities and nasal cavities will continue to produce lots and lots of mucus. Perhaps this stuff is hanging up in his nasopharynx (the top part of the throat).

If the ENT confirms this and rules out the somewhat more serious possibility of recurrent sinus infection, then your husband has a few good options. The best, in my opinion, would be to adopt a routine of nasal irrigation as part of his morning ritual. Nasal douching does wonders for clingy mucus. The solution may be even simpler than that; some folks improve markedly if they increase their intake of noncaffeinated, nonalcoholic fluids.

In summary, I would go to an ENT first, and hold off on the lawyer.

D.

Intracapsular tonsillectomy

Q: I [identifying information deleted] have been treated with antibiotics 7 times in the last 12 months for 'strep throat.' It is likely that I will have a tonsillectomy soon.

I am looking for information about intracapsular tonsillectomies for adults. So far, ENTs I have talked to here seem to think it's not a surgery that works in adults. (They may not have any experience doing it which may be the issue as well.) I am writing to you because your website mentions that you have performed these surgeries.

I have looked for research confirming that it can work in adults, but have found nothing especially helpful. I am also looking for information concerning who in New England might be willing to do an adult intracapsular tonsillectomy.

Any information or help that you can provide would be incredibly helpful. I am considering writing a research proposal concerning the topic if I can not find decent research on the topic.

Thank you for your time.

A: You're right. It is difficult finding information on the web regarding adult intracapsular tonsillectomy. Here's something from Bryn Mawr Hospital:

For adults, the new procedure may not be as effective as it is in children because the tonsils will have become scared and rubbery from repeated infections, compared with the fluffy tonsils of a child. "Adult tonsils don't shave out as easily, but we will try the partial tonsillectomy first," he said. "If the procedure becomes difficult, we can convert to a traditional tonsillectomy."

I have been doing adult intracapsular tonsillectomies for the last 12 to 18 months, and I know a lot of my colleagues are doing the same. I would agree with the above author that some adults are poor candidates for this -- those whose tonsils are scarred down. Adults with larger tonsils, more typical of what we see in children, are better candidates. The trouble with scarred tonsils is that it becomes challenging if not impossible to leave behind a thin layer of tonsil tissue, which is the aim of the intracapsular technique.

As you have no doubt heard, adult tonsillectomy can be very painful, and the intracapsular technique is a definite improvement with regard to post-op pain. In my experience, even those adults who end up having a complete tonsillectomy still seem to do better post-operatively. Thus, I agree with the above author who always tries the intracapsular method first.

Hopefully, I can get a few of my colleagues to add their thoughts, too.

D.